Affect and alcohol use: an ecological momentary assessment study of outpatients with borderline personality disorder.

Borderline personality disorder (BPD) affects 1% to 3% of the general population and is a common personality disorder in clinical settings (Lenzenweger, Lane, Loranger, & Kessler, 2007; Trull, Jahng, Tomko, Wood, & Sher, 2010). BPD is frequently comorbid with both Axis I disorders and personality disorders (Skodol et al., 2002). In particular, BPD is highly associated with substance use disorders, especially alcohol use disorders (AUDs; Trull et al., 2000). For example, Trull et al. (in press) estimated that, on average, 16.9% of individuals with an AUD diagnosis also receive a BPD diagnosis, and 45.1% of those with BPD also receive an AUD diagnosis. One prominent theory of the etiology of AUDs may at least partially explain this association (Sher & Grekin, 2007). The use and ultimate abuse of alcohol may represent an attempt to regulate negative emotions (Sher, 1991; Trull et al., 2000). Specifically, those who experience negative emotions more frequently and intensely, and who have trouble regulating these negative emotions, are more prone to develop alcohol use problems. The effects of alcohol may be negatively reinforcing in that alcohol’s anxiolytic properties serve to decrease feelings of negative affect or acute distress (Baker et al., 2004) and provide some temporary relief. In addition, the belief that alcohol will alleviate negative affective states may also be powerful. Alternatively, alcohol may serve as a positive reinforcer by increasing positive mood states (Sher, 1991). BPD is perhaps the prototype of emotional dysregulation (Linehan, 1993; Trull et al., 2000). Emotional dysregulation or affective instability refers to the experience of acute, extreme changes in affect or the experience of aversive affective arousal. Emotional dysregulation involves a heightened emotional sensitivity, greater and more intense emotional reactivity, and a slower return to baseline arousal (Linehan, 1993). Furthermore, emotional dysregulation appears to underlie and drive the core features of this disorder, including affective instability, impulsivity, substance use problems, interpersonal problems, and identity problems (American Psychiatric Association, 2000; Trull, Tomko, Brown, & Scheiderer, 2010). Therefore, individuals with BPD seem both biologically and psychologically motivated or predisposed to abuse alcohol (Trull et al., 2000).